INJECTION THERAPY FOR OSTEOARTHRITIS OF THE THUMB

What is Osteoarthritis of the thumb?

Osteoarthritis of the thumb is a long-term disorder that causes pain, stiffness, and swelling in the joint near the base of the thumb (also known as the carpometacarpal or CMC joint). Simple actions like slicing food can become excruciatingly uncomfortable and difficult. Thumb osteoarthritis becomes more common as people get older. It usually begins with modest discomfort and stiffness and worsens over time for no obvious reason.

Although there is no cure for osteoarthritis, there are effective treatments that can help you manage your pain and improve your function. Resting away from aggravating factors, using a thumb spica, taking painkillers/anti-inflammatories, and going to physiotherapy can all help to relieve discomfort and increase mobility and strength. Steroid injections guided by ultrasound can provide immediate pain relief. Following injections, a course of physiotherapy should be completed, which may include exercises, hands-on/manual therapy, and/or acupuncture. Hyaluronic acid injections are a good alternative to steroid injections since they lubricate the joint and help with movement and pain relief. Joint replacement surgery is intended for people who are in excruciating pain that hasn’t responded to injections or rehabilitation.

What are the symptoms of Osteoarthritis of the thumb?

The following are the signs and symptoms of thumb osteoarthritis:

  • At the base of your thumb, there is swelling, stiffness, and soreness.
  • When pinching or holding objects, especially between your thumb and index finger, you may experience pain and weakness (pincer grip).
  • The joint at the base of your thumb appears enlarged, thickened, or bony.

If this sounds like you, keep reading…

What are some additional conditions that are similar to Osteoarthritis of the thumb?

If this does not sound like your pain, there are a number of other disorders that can cause pain similar to osteoarthritis of the thumb, including:

  • Carpal tunnel syndrome
  • DeQuervain’s tenosynovitis
  • Osteoarthritis of the wrist
  • Triangular fibrocartilage complex (TFCC) tear
  • Scapholunate ligament injury

Osteoarthritis (OA) of the thumb vs DeQuervain’s tenosynovitis:

Localized pain, stiffness, and edoema around the joint at the base of the thumb are symptoms of thumb osteoarthritis. DeQuervain’s illness, on the other hand, causes pain and swelling on the thumb side of the wrist near the wrist crease. Thumb movements, clutching, and carrying aggravate both disorders. Thumb osteoarthritis is more common in people over 50, whereas DeQuervain’s disease is more common in younger men and women, especially those who have just given birth.

Anatomy:

The first carpometacarpal (CMC) joint is located at the base of your thumb. It connects your thumb to your wrist and is crucial in the development of the complicated series of movements that the thumb is capable of. The trapezium bone (one of the minor carpal bones of the wrist) and the metacarpal bone of the thumb articulate to form the first CMC joint (the first long bone at the base of your thumb). Because of its complex’saddle’ shaped morphology, this joint can perform a variety of movements. The first CMC joint can be seen in the image below.

The first CMC joint is in charge of generating the following motions:

Thumb flexion (crossing your thumb across the palm of your hand) and extension (extending your thumb across the palm of your hand) (moving your thumb away from palm).
Thumb abduction (moving your thumb towards your fingers) and adduction (drawing your thumb away from your fingers) (separating your thumb away from your fingers).
The thumbs are in opposition to each other. This is the motion that permits your thumb to reach over and touch your little finger in a circle.
Osteoarthritis commonly develops in the first CMC joint. This is owing to the thumb’s continual mobility throughout the day. According to a recent study, 2.2 percent of people with hand pain have first CMC joint osteoarthritis (Kwok et al, 2014).

There are numerous risk factors that are associated with the first CMC and includes the following:

  • Age: After the age of 50, the prevalence of first CMC joint osteoarthritis increases significantly (Sonne-Holm et al, 2006)
  • Gender: Women are more likely than males to develop first-stage CMC joint osteoarthritis (Sonne-Holm et al, 2006)
  • The presence of osteoarthritis in the first CMC joint is directly related to a high BMI.
  • Trauma – Previous traumas to the joint, such as thumb dislocations, can predispose it to osteoarthritis. Thumb dislocations are prevalent during sports like skiing.
  • Occupation – Some vocations (for example, construction) necessitate repetitive thumb movements, which can predispose the thumb to osteoarthritis over time.
  • Sporting activities – Some sports, such as tennis, need repetitive activity.

Osteoarthritis is a degenerative disorder that develops when the thumb is exposed to one or more of the risk factors listed above over an extended length of time.
The bones of the first CMC joint (trapezium and first metacarpal bone) are coated in articular cartilage to allow fluid, frictionless movement and to offer a layer of protection. This articular cartilage can be worn down if the joint is subjected to repeated periods of misuse, overuse, or abuse. The sensitive bone surfaces, which were previously shielded by a layer of cartilage, become exposed and rub together as time passes. The synovium, the connective tissue within the joint area, becomes irritated and inflamed as a result of this process, resulting in synovitis. Synovitis is the cause of the intense pain flare-ups associated with osteoarthritis, and it has been linked to disease progression.

How do I know If I have Osteoarthritis of the thumb?

Osteoarthritis is a slow-progressing condition that might take years to manifest before becoming symptomatic. Symptoms are generally sporadic at first, generating low levels of pain, but as the condition progresses, they become more constant and intense.

The following are symptoms of osteoarthritis in the CMC joint for the first time:

  • At the base of the thumb, there is a dull agonising discomfort.
  • Sharp bouts of heightened discomfort near the base of the thumb that come and go. Synovitis is frequently connected with this condition.
  • The base of the thumb is swollen.
  • The thumb joint is making clicking or cracking noises.
  • Stiffness. As osteoarthritis advances, your joint movement may be limited.
  • The base of the thumb has thickened and expanded. This is related to a change in joint shape known as joint deformation, which is linked to more severe forms of osteoarthritis.
  • Gripping and pinching movements such as opening a door, opening a jar, shaking hands, and turning a key are all affected by thumb weakness.

How is Osteoarthritis of the thumb diagnosed?

A precise diagnosis of first CMC joint osteoarthritis is critical since it tells the clinician about the best treatment option for you.

If you think you could have osteoarthritis in your thumb, you should see a doctor. The diagnosis of CMC joint osteoarthritis is made utilising a mix of clinical testing (such as thumb range of motion and strength testing) and diagnostic imaging (e.g. x-ray).

If your doctor suspects you have osteoarthritis, he or she will likely refer you for an x-ray. An x-ray is a highly effective diagnostic tool for evaluating bone and joint health, and it may also be used to measure the severity of osteoarthritic change in a joint. Blood tests may be ordered by your doctor. These tests are performed to rule out systemic inflammatory processes, which can also produce thumb pain. X-rays are excellent in detecting the presence and severity of osteoarthritis, but they do not always correlate with pain and symptoms. After analysing x-ray findings, patients frequently experience pain and symptoms that are more severe than expected. This is particularly true during a pain flare-up. An x-ray of the hand and wrist is shown below, with the 1st CMC joint highlighted.

Diagnostic musculoskeletal ultrasound imaging is a routinely utilised evidence-based diagnostic technique for assessing first-degree CMC osteoarthritis. Diagnostic ultrasonography is particularly good at detecting bone abnormalities associated with osteoarthritis and at detecting inflammation associated with synovitis (Kaeley et al., 2020; Wakefield et al., 2000). Joint Injections has a staff of highly trained clinicians who are also qualified musculoskeletal sonographers with experience detecting first-stage CMC osteoarthritis. During the examination, your clinician will perform a clinical examination of your thumb and a diagnostic ultrasonic scan of the area.

How do we treat Osteoarthritis of the thumb?

The great majority of patients benefit from physiotherapy treatment that combines thumb stretches and strengthening exercises. Strength and flexibility are the most essential components in maintaining function and lowering discomfort in osteoarthritic joints, according to current research. Following an assessment of your thumb by your physiotherapist, you will be given a tailored progressive training programme focused at maintaining strength, flexibility, and function. In some circumstances, your physiotherapist may use manual release techniques to expand your range of motion, which may include moving your thumb. A thumb splint may also be recommended by your doctor. Splints are commonly used to limit unpleasant movements while allowing you to keep your thumb active.

Here are a few pointers you might want to try:

  • As much as possible, avoid painful activities. If this isn’t possible, attempt to adapt these exercises as much as possible. Taking regular breaks, altering hand and wrist positions, or utilising a splint are all options.
  • Gentle thumb stretches are a good option. Flexibility has been shown to help those with osteoarthritis.
  • Exercises to enhance your grip should be done. Squeezing a ball, rolled up socks, or a tennis ball can be used for this.
  • To acquire extra purchase during daily activities, try using assistive aids like jar openers or tap turners.
  • Pain relief can be achieved by using over-the-counter pain relievers like paracetamol or applying a topical anti-inflammatory gel like Voltarol. Please ask your pharmacist first.

How do we treat Osteoarthritis of the thumb?

If your thumb pain persists despite physiotherapy or is interfering with your everyday activities, an ultrasound-guided steroid injection may be right for you.

A corticosteroid is an anti-inflammatory injectable medicine that is commonly used to treat the pain and inflammation associated with osteoarthritis. When your pain is impacting the following, corticosteroids are especially effective:

  • Having an effect on your capacity to sleep or waking you up in the middle of the night.
  • preventing you from performing daily tasks such as cooking, dressing, and cleaning, as well as recreational activities such as gardening or racquet sports
  • Your ability to participate in your physiotherapy treatment is being harmed.

Corticosteroid injections administered under the direction of ultrasonic imaging have been found to be more effective and precise. Real-time Ultrasound imaging is used to achieve precise needle placement.Hyaluronic acid is a man-made substance that mimics the natural lubrication of joints. According to current evidence, it is an excellent alternative to corticosteroid injection in arthritic joints for lowering pain and inflammation. The same process as a corticosteroid injection is used to inject hyaluronic acid under ultrasound guidance.

All of our specialists at Joint Injections have performed ultrasound-guided injections before. Your clinician will be able to assess your thumb and, if necessary, perform an ultrasound-guided injection during your initial consultation. For all ultrasound-guided injections, Joint Injections can provide a same-day service. You do not need to bring a prescription or be referred by a doctor. Prior to the injection, your doctor will be able to choose and prescribe the most beneficial drug for you. We recommend commencing physiotherapy within two weeks of any ultrasound-guided injection for the greatest possible benefits. Injections create a ‘window of opportunity’ for you to effectively heal your thumb joint without pain.

Joint Injection’s experts are dual-trained, highly specialised physiotherapists and musculoskeletal sonographers with extensive experience diagnosing all hand and wrist disorders, including Trigger Finger. We provide a ‘one-stop’ clinic, which means you’ll get an examination, a diagnostic ultrasound, and, if necessary, an ultrasound-guided injection.